Gut Check on Gastroenterology, an NEJM Journal Watch blog focusing on issues in clinical gastroenterology, was active from 2008 to 2014. This archive contains all posts and discussions from Gut Check’s history.

December 11th, 2009

Should Propofol Be Used for Routine Endoscopy?

Propofol is a remarkable drug that has revolutionized sedation for patients undergoing endoscopic procedures. It can produce rapid and, when necessary, deep sedation, and its effects can be reversed within seconds to minutes. Because it has proven to be more effective than hypnotics (such as versed) and narcotics (such as fentanyl), an estimated 40% of all endoscopic sedation in the U.S. is now being performed with propofol.

Unfortunately, because propofol is labeled an anesthetic, GI docs in most hospital endoscopy units are blocked from using the drug by the hospitals’ anesthesia departments, which set sedation policies. Such policies persist, largely because of ongoing turf wars, despite documentation of more than 500,000 cases of safe propofol administration by nurses under GI-doc supervision.

Given the restrictions on propofol use, many endoscopists have resorted to calling in anesthesiologists or anesthetists to administer the drug in routine cases. But does this response meet the highest standards of professionalism? In my opinion, the turf war is wrong, but it does not justify introducing the cost of an anesthesia provider into routine endoscopic procedures.

I suspect many of you have strong opinions about this one way or the other, so please weigh in on the subject.

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21 Responses to “Should Propofol Be Used for Routine Endoscopy?”

I have had multiple procedures with with Milk and with Versed/Fentyl. The former added $800 to the bill and I was incubated also. Fentyl works well and since my boarded GI man is both a patient and a provider and prefers the F/V combo as I do, we work well together. He is in his 40’s and is not ready for retirement.